Lying in an ambulance as it raced toward a hospital in Hampton, Va., Ashley Matthews was not thinking about the injuries she had just suffered in a car accident. She was more concerned about the bill she was about to rack up in the emergency room.
It was 2008 and Matthews, who had been celebrating her acceptance to the University of Miami School of Law the night the accident occurred, had no health insurance.
"I had been keeping up with the ongoing dialogue on the rising costs of health care," Matthews told a panel last week on the Affordable Care Act. "I was terrified that I'd be burdened with a huge bill. So I left the hospital."
Fortunately, the injuries to her mouth and knee proved minor. Today, Matthews, 25 years old and a third-year law student at UM, would not have to avoid proper medical attention. She is covered under an Affordable Care Act provision that allows young adults to remain on their parents' health care plan until they are 26.
"We have two-and-a-half million young Americans like Ashley, who today have coverage [but] in 2010 did not," U.S. Secretary of Health and Human Services Kathleen Sebelius told the same panel at the Jessie Trice Community Health Center in northwest Miami on March 20. The panel discussion, moderated by UM President Donna E. Shalala – who in the Clinton administration held the cabinet post that Sebelius now occupies – focused on how the Affordable Care Act is helping women and other segments of the population.
Greater access to preventive services such as cancer screenings and well-woman visits is one of the law's most important attributes, Sebelius said. "We know that already, almost 21 million women have used preventive services without cost-sharing [co-pays], and that's a big step forward," she explained.
Sebelius also touted features such as lower prescription drug costs for seniors in the so-called "doughnut hole" coverage gap and, taking effect in 2014, a provision that makes it illegal for insurers to deny coverage to people with pre-existing conditions. More benefits are coming in August and in 2014, when the plan's major components kick in, the secretary said.
The secretary's Miami stop, part of a weeklong, multicity tour to commemorate the second anniversary of the act, came as the Supreme Court was set to begin hearings this week on the constitutionality of the law.
Speaking to an audience composed mostly of women, many of them community leaders, Sebelius noted a recent study by the National Women's Law Center that found that the practice of "gender rating" – charging women more than men for the same coverage – costs women $1 billion a year, and yet women still do not receive all the coverage they require.
"In the insurance market, women had the worst deal possible," she said. "Not only did we pay more, traditionally, for coverage, but the coverage didn't cover women's health needs. So you pay more to get insurance in the first place, and then pay a lot more out of pocket because a lot of the services weren't included in the plan."
Sebelius said the Affordable Care Act has pumped millions of dollars into the nation's community health centers, allowing such facilities to train more workers and expand their hours and services. More than $81 million in aid has gone to community health centers in Florida alone, she noted.
Calling the Affordable Care Act the "most historic piece of legislation since Medicare," President Shalala said the plan will help reverse disturbing numbers in the City of Miami, where 50 percent of the residents between 18 and 64 years old lack health insurance.
The audience heard from other panelists, who told personal stories of how the law has provided a boost to their efforts to stay healthy. Matthews, the only student on the panel, has advocated for health care reform since she arrived at UM, joining the Miami Health Equity Project, a coalition of women leaders and law students who visit communities to educate women about reproductive justice. She said she felt fortunate to be covered on her patents' health plan, an advantage echoed by Sebelius.
Young people, the secretary explained, represent the second most likely age category to be uninsured. "They are all an accident or a diagnosis away from a lifetime of bills, or a life or death situation where they have to choose [between] treatment or paying the rent," Sebelius said. "So having coverage available on a parent's plan up to the age of 26 has been a great benefit."
Among the others who spoke: Isabella Rosete, an immigrant from Venenzuela who lives in Miami's Brownsville neighborhood and receives health care at Jessie Trice, one of the community centers partly funded by the Affordable Care Act; Marilyn Bruno, a Medicare advocate; and Molrine Tracey, an obstetrician and gynecologist who earned her undergraduate degree at UM and now treats patients at Community Health of South Florida.
Another third-year law student, Amanda Leipold, said that the Miami Health Equity Project includes representatives from Florida Legal Services, Law Students for Reproductive Justice, Power U Birth Justice Project, Mi Lola and other groups.